Herpes zoster radiculopathy

The same virus which causes chicken pox and shingles can cause lumbosacral radiculopathy. The incidence is more common than most people realize; one to two per thousand in the general population. The incidence is more common than most people realize; one to two per thousand in the general population. The incidence increases with age, so that it is ten per thousand during the ninth decade of life. Statistically, 6 percent have a prior history of cancer. Eight percent of leukemia and lymphoma patients develop herpes zoster. Twenty-five percent of Hodgkin’s patients develop herpes zoster. The incidence is greater in those who have had a splenectomy, chemotherapy, or radiation therapy within one year. There is no lasting immunity from a prior episode of herpes zoster; a significant percent of patients have recurrent episodes.

The onset is always spontaneous. Pain generally precedes vesicular lesions by a few days. Skin lesions may be delayed for up to three weeks. Ten to 20 percent have post-herpetic pain, and this is more common in the older population. In addition, systemic complaints are noted in 5 percent, such as headache, fever or nausea. The location is almost always a single dermatome. It may involve motor branches, and almost always includes sensory symptoms. Fifty percent involve thoracic roots, with the remainder distributed between cranial, cervical, lumbar, and sacral roots. There is no clear relationship of pain to position movement, or activities. Up to 30 percent may develop weakness according to the literature, but more than 55 percent of these will recover fully and 30 percent significantly. There is, therefore, a relatively small percent of the total population who are left with any significant weakness.

Diabetic radiculopathy

These patients are usually middle aged or elderly, as this condition is often seen in adult onset diabetes mellitus. The literature has not been careful with distinguishing diabetic plexopathy, amyotrophy, and radiculopathy. Pain is universally experienced and sensory as well as motor complaints are common. The pain is generally constant and is worse at night, and occasionally there is an associated weight loss. There is rarely a mechanical factor, a fact which helps distinguish this from disc, stenosis, and spondyllolisthesis.

Arachnoiditis

Studies reveal nearly universal existence of adhesions and scar formation in post-operative patients as well as many patients with disc disease who have not been operated on. Most patients with scar adhesions are not symptomatic. Unfortunately, the radiographic results do not allow distinction between those who do and those who don’t have symptoms. However, patients who have experienced disc space infections, subarachnoid hemorrhage, multiple surgeries, intrathecal drugs, prior radiation therapy, or had received pantopaque myelography, are all predisposed to develop arachnoiditis.

Unlike disc disease, symptoms are reproduced in virtually all planes of motion. However, like disc disease, symptoms are especially reproduced with trunk flexion and with long stride with gait. Sitting, lifting, and Valsalva maneuvers are often not uncomfortable in patients with arachnoiditis, unlike those with disc disease.

Conclusion

There are numerous other conditions which can cause radiculopathy. The purpose of this presentation has been to help to focus some of the key elements of medical history in separating etiologies of lumbosacral radiculopathy so that patients can be more efficiently referred for appropriate treatment. If our clinical acumen can be sharpened so that patients seen for initial history and physical examination can bae appropriately directed, the likelihood of treatment success can be greatly enhanced.